"This graphic study of a tormented killer and the vulnerable listener who alone can identify him is Lucarelli's first book to be translated into English and it's a stunning tour de force." - The Telegraph

"Lucarelli’s short and nasty noir thriller is a treat from beginning to end. (...) Lucarelli exerts a terrific narrative force on the reader." - Chris Power, The Times

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Almost Blue plays with sensory perceptions, especially hearing.
The narrative switches back and forth between three perspectives, the reader put inside the head of both the serial killer that's on the loose and of a blind man with a finally honed sense of hearing, while also relating the police investigation, as led by young female inspector Grazia Negro.
The blind Simone spends much of his time listening to radio scanners, which allow him to listen in on everything from police radio calls to telephone conversations.
There have been a series of murders of students in Bologna, and while the police is reluctant to attribute them all to one serial killer it becomes clear that they are all the work of the same very brutal hands: "the M.O. is always the same: a bestial force massacres everything in its path".
Simone overhears the voice of the murderer and thus eventually becomes a vital part of the police investigation -- but because he's blind he can only identify the murderer by his voice.
Identifying the murderer turns out not to be that hard, as he left his fingerprints at the scene of a crime, but that doesn't get them very far.
Still, the records they have on him -- doled out bit by bit in the novel -- give some insight into his mania.
They call him 'the Iguana', because of his ability to change the way he appears completely, blending in and taking on the appearance of his victims.
It becomes a chain of crime, as: "In each case the victim of the prior homicide was somehow present."
The Iguana also has auditory issues: he hears bells in his head, and he tries to drown them out with loud music, generally walking around with headphones on.
What he hears in his head overwhelms him, causing him to inflict pain to himself and to others.
Topping everything off is Grazia Negro as lead investigator, new to the job and a woman at that, in what is clearly still a man's world; Lucarelli fumbles a bit in driving that home so often ("Her thoughts went to the container of tampons in her jacket pocket next to the spare Beretta cartridge clip" ...).
Lucarelli does a decent job of playing with sensations, especially in the mix of auditory and visual, as Simone, for example, assigns colours (he's never seen) to sounds and voices.
The helplessness of the blind, as well as the heightened acuity of Simone's (hearing) perception are also well used.
While the serial killer is over-the-top, Lucarelli lets shock value come almost in the asides, which actually works well in building up the tension.
Only occasionally does he get caught up in the excess, as in the opening scene, or when Grazia arrives at a crime scene and is warned:

"Watch out, signorina ... most of the blood's dry now, but there's still some on the ceiling that drips down occasionally."

With its shifting perspectives and fast pace (and repetition of some themes), Almost Blue resembles a jazz piece.
While the serial killer and his motives are rather generic (and in the conclusion, when he hears no more bells, decidedly anticlimcatic), Simone and Grazia are more interesting characters.
It feels a bit sketchy in part, especially the character-development, but that's outweighed by the way the narrative effectively moves along.
Lucarelli doesn't seem quite sure what sort of police procedural he wants to write, but it's a solid, creepy little novel.